The World Stroke Organization estimates that 1 in 4 persons will have a stroke in a lifetime. This is worrisome. Stroke is the 3rd highest killer after Ischaemic heart disease and cancer. hence it has become a public health emergency. Regrettably, the prevalence of stroke is very high in Sub-Saharan Africa. In the same way, the high stroke mortality is also much higher in SSA. the prevention of stroke is possible. It involves screening for risk factors like Hypertension, Diabetes, Cholesterol disorders , cardiac diseases and others. thereafter, these diseases should be treated. more importantly, there is a need for lifestyle modification. This involves the following: healthy diet, exercise, reduction of Alcohol intake and salt etc. This is a Health Talk on the prevention of Stroke for everyone out there who wants to take charge of their health conditions. The presentation is prepared in an easy way. It has very colourful pictures.

1. PREVENTION of STROKE
DR BERTHA CHIOMA EKEH
A Health Talk given at SUN NEWSPAPERS on Sept 28th 2022

2. Disclosure
Dr Bertha Chioma Ekeh; B, Med Pharmacology, MBBS, FMCP (Neuro)
Associate Professor of Internal Medicine /Consultant Neurologist
University of Uyo/University of Uyo Teaching Hospital
Adjunct Consultant Neurologist Ibom Specialist Hospital Uyo
Public Speaker
Author
webpage https://www.amazon.com/Dr-Bertha-Chioma-Ekeh/e/B07D442KRX
Blog https://medicalinfoblog.net
Email addresses berthaekeh@uniuyo.edu.ng, berthacekeh@yahoo.com
I HAVE NO CONFLICTS OF INTEREST

3. Content
 Introduction
 Impact of Stroke
 Stroke Mortality
 Risk factors
 Prevention(AHA/ASA Guidelines)
 Emphasis on Hypertension/Review of Studies
 Others
 Summary and Conclusion

4. Introduction 1
 Local languages
 Igbo : Mba Agbara ( A hug from the spirit)
 Ibibio: Ekpo mia ( A slap from the Spirit)
 Yoruba :Ofa ( An evil arrow)
 Hausa Shanna Inna ( Sudden paralysis)
 Defines the dramatic symptoms
 Medical name Cerebrovascular Disease

5. Introduction 2

6. Impact of Stroke
 Public Health Emergency
 I in every 4 persons will have a Stroke in a lifetime
 Every 6 seconds someone somewhere dies from stroke
 6 million people die every year from a stroke
 High burden of Stroke in SSA
 High Mortality
 Large burden of Disability

7. Impact of Stroke
 Public Health Emergency
 I in every 4 persons will have a Stroke in a lifetime
 Every 4 seconds someone somewhere dies from stroke
 6 million people die every year from a stroke
 High burden of Stroke in SSA
 High Mortality
 Causes a lot of disabilities
 Minor negligible strokes leading to cognitive deficits of frank dementia

8. Impact of Stroke
 Winston Churchill, Franklin Delano Roosevelt and Josef Stalin
Yalta conference post
World War II on the 4th
February 1945
“The history of the world might
have been different if the brains of
these leaders had not been addled
by strokes”-
Dr Louis. R Caplan

9. Nigeria
 Crude prevalence rate of stroke in urban Nigeria is1.14/1000
 Every Nigerian knows or is related to someone
who has had a stroke before.

10. Types of Stroke
 Ischaemic seen in 80-85% of cases
 Haemorrhagic

11. Types of Stroke
Ischaemic Stroke
Haemorrhagic Stroke

12. Projected global
deaths by
causes (all ages,
2005)
0
2,000,000
4,000,000
6,000,000
8,000,000
10,000,000
12,000,000
14,000,000
16,000,000
18,000,000
Deaths
CVD
Cancer
Resp Dis
HIV/AIDS
TB
Diabetes
Malaria
Source: WHO 2005

13. Risk factors
 Non modifiable
 Elderly age>55
 Male sex
 Black race
 Family history
 SCD

14. Modifiable
 Hypertension; best recognized risk factor
 Diabetes mellitus
 Cardiac diseases
 Dyslipidaemias
 Obesity
 Excessive alcohol intake
 Cigarette Smoking
 Cocaine and other recreational drugs
 Etc

15. Uncultured societies: 0%
 Early surveys in the Samburu (East Africa)
 Yanomami Indians (South America)
 Unpublished reports about the Koma in Nigeria
 No rise in BP with age
 Rise with migration, westernisation

16. Symptoms of
Stroke

17. Brain Attack
 Creates a sense of need for urgent action similar to ‘heart attack’

18. Stroke unit; State of the Art Care
 Specialized
 Multidisciplinary Mgt
 Brain Imaging
 Thrombolysis
 Neurosurgery Support
 Nursing Care
 Etc

19. Challenges in Nigeria
 Lack of awareness
 Poor knowledge
 Late presentation
 Access to the hospital
 Access to CT scan
 Cost
 Lack of stroke unit
 Training of personnel

20. Prevention
 Primary
 secondary

21. Primary Prevention
Remains the most important factor in the
reduction of the burden of stroke
The best stroke is the stroke you never
had!!!!

22. Modalities
 Know your numbers
 Pharmacological Treatment
 Lifestyle Modification

23. Blood pressure

24. Blood sugar
 Accessible
 Control

25. Cholesterol
 Note

26. Good health seeking behaviour
 See your Doctor
 May need some investigations
 Take your medications as prescribed by your Doctor

27. Lifestyle modification

28. Healthy African Diet

29. Qualities of Healthy Food
 Fresh food
 Unprocessed/minimally processed food
 Plant oils
 Fruits and vegetables
 Drink water

30. Cooking Methods
Boil
Steam
Roast
Grill without oil

31. Drink Water

32. Salt intake

33. Reduce Alcohol Intake

34. French Paradox

35. Quit smoking

36. Exercise

37. NEAT

38. NEAT: Types
 Use the stair case
 Park at a distance
 Walk up and down the stairs
 House work
 See off visitors
 Stand to sing and pray
 Standing tables
 Use a pedometer( counts your steps)

39. Sitting is the New Smoking!!!!

40. Dangers of sitting
 Causes reduced metabolism and burning of fat leading to:
 Obesity especially around the waist
 Hypertension
 Diabetes
 High cholesterol
 Leisurely moving is beneficial!!!

41. Standing Tables

42. Pray
 Even the dog
Even the dog

43. Summary and Conclusion
 High stroke burden and mortality in SSA
 Primary prevention is the best way to reduce the burden
 Hypertension is the commonest and most recognizable ‘modifiable’ risk factor
 Control of all the modifiable risk factors is very important
 Lifestyle modification is pertinent

44. Conclusion
THE BEST STROKE IS THE STROKE YOU
‘NEVER’ HAD !!!!!!!